Elsevier

Heart Rhythm

Volume 10, Issue 2, February 2013, Pages 172-175
Heart Rhythm

Recovery from left ventricular dysfunction after ablation of frequent premature ventricular complexes

https://doi.org/10.1016/j.hrthm.2012.10.011Get rights and content

Background

Patients with frequent premature ventricular complexes (PVCs) and PVC-induced cardiomyopathy usually have recovery of left ventricular (LV) dysfunction postablation. The time course of recovery of LV function has not been described.

Objective

To describe the time course and predictors of recovery from LV dysfunction after effective ablation of PVCs in patients with PVC-induced cardiomyopathy.

Methods

In a consecutive series of 264 patients with frequent idiopathic PVCs referred for PVC ablation, LV dysfunction was present in 87 patients (mean ejection fraction 40%±10%). The PVC burden was reduced to<20% of the initial PVC burden in 75 patients. In these patients, echocardiography was repeated 3–4 months postablation. If LV function did not normalize after 3–4 months, a repeat echocardiogram was performed every 3 months until there was normalization or stabilization of LV function.

Results

The ejection fraction normalized at a mean of 5±6 months postablation. The majority of patients (51 of 75, 68%) with PVC-induced LV dysfunction had a recovery of LV function within 4 months. In 24 (32%) patients, recovery of LV function took more than 4 months (mean 12±9 months; range 5–45 months). An epicardial origin of PVCs was more often present (13 of 24, 54%) in patients with delayed recovery of LV function than in patients with early recovery of LV function (2 of 51, 4%; P<.0001). The PVC-QRS width was significantly longer in patients with delayed recovery than in patients with recovery within 4 months (170±21 ms vs 159±16 ms; P = .02). In multivariate analysis, only an epicardial PVC origin was predictive of delayed recovery of LV function in patients with PVC-induced cardiomyopathy.

Conclusions

PVC-induced cardiomyopathy resolves within 4 months of successful ablation in most patients. In about one-third of the patients, recovery is delayed and can take up to 45 months. An epicardial origin predicts delayed recovery of LV function.

Introduction

Frequent premature ventricular complexes (PVCs) can cause a reversible form of cardiomyopathy.1, 2 The time course and the determinants of recovery of left ventricular (LV) function are not known. The purpose of this study was to describe the time course and predictors of recovery from LV dysfunction after an effective ablation of PVCs in patients with PVC-induced cardiomyopathy.

Section snippets

Patient characteristics

In a consecutive series of 264 patients (121 men; age 48±14 years) with frequent idiopathic PVCs, LV dysfunction was present in 87 patients. PVC-induced cardiomyopathy was defined as an ejection fraction of<50% that normalized after ablation or an ejection fraction of 50%–55% with an improvement of≥10% after PVC ablation. All patients underwent an assessment for the presence of structural heart disease with echocardiography, stress testing, and/or cardiac magnetic resonance imaging (MRI).

Recovery of LV function

A total of 75 patients with PVC-induced cardiomyopathy had an effective ablation procedure. The PVC burden was reduced from 26%±11% to 2%±4% (P<.0001). LV function changed from 39%±10% to 59%±4% (P<.0001) in patients who had PVC-induced cardiomyopathy and had an effective ablation procedure. The ejection fraction improved or normalized in all patients with PVC-induced cardiomyopathy. Twenty-four of 75 (32%) patients had delayed recovery of LV function. In the remaining patients, LV function

Main findings

In the majority of patients with PVC-induced cardiomyopathy, the ejection fraction normalized within 4 months of the ablation procedure. In about a third of the patients, recovery of LV function was delayed. The ejection fraction eventually normalized or substantially improved in all patients with PVC-induced cardiomyopathy who had a successful ablation procedure. The only independent predictor for delayed recovery was an epicardial origin of the ablated PVC.

Recovery of LV function

In the majority of patients, the

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1

Dr Bogun has received a grant from the Leducq Foundation.

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